Provider Demographics
NPI:1760556096
Name:JAGATIC, SARAH E (OD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:JAGATIC
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:NEEDHAM
Other - Last Name:JAGATIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:505 W HOLLIS ST STE 109
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-1386
Mailing Address - Country:US
Mailing Address - Phone:603-882-0311
Mailing Address - Fax:603-668-0881
Practice Address - Street 1:505 W HOLLIS ST STE 109
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-1386
Practice Address - Country:US
Practice Address - Phone:603-882-0311
Practice Address - Fax:603-417-2982
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0797152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE8928OtherMEDICARE
NH30354733Medicaid
0340350001Medicare NSC
NHV10998Medicare UPIN
V10998Medicare UPIN